Active NPI
David Jezyk, MD
- Family Medicine Physician
- Wilmington, DE
National Provider Identifier
1093828014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- CI-0D00967
- Practice address
- 4515 Griffin Dr
Wilmington, DE 19808-4254 - Phone
- (302) 999-7364
- Fax
- (302) 424-9362
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CI-0D00967 | DE | Primary |
Addresses
Primary practice location
4515 Griffin Dr
Wilmington, DE 19808-4254
Mailing address
4515 Griffin Dr
Wilmington, DE 19808-4254
Phone (302) 999-7364
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000191701 | Medicaid | DE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CI-0D00967 | DE | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544832000000",
"number": "1093828014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4515 GRIFFIN DR",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198084254",
"telephone_number": "302-999-7364",
"fax_number": "302-424-9362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4515 GRIFFIN DR",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198084254",
"telephone_number": "302-999-7364",
"fax_number": "302-424-9362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEZYK",
"first_name": "DAVID",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2018-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "DE",
"license": "CI-0D00967",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000191701",
"state": "DE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.